This is the conclusion of his recent research Hetana AharKellogg assistant professor of marketing.
Achar wanted to understand whether our desire to protect our self-image would make us less likely to take healthy actions if the relevant health problems were directly linked to stigmatized behaviors.
Take cervical cancer for example. “Regular cervical cancer screening is a healthy, beneficial practice,” she says. “But having multiple sexual partners, a risk factor for cervical cancer, is stigmatized in many societies. In such societies, some people may put their health at risk to avoid being associated with something that others think is ‘bad’.”
Achar et al Leah Dunn and Nidhi Agrawalboth at the University of Washington, used this rationale as a basis for a series of studies about how stigmatized risk factors affect our willingness to keep ourselves healthy.
Researchers have found that the social stigma surrounding certain health risk factors, such as smoking, being overweight or having multiple sexual partners, can have a direct impact on the way we think about and deal with our health. Specifically, people who define their identity around being a good person—what Achar calls a “high moral identity”—may decide to engage in health behaviors depending on whether the associated risk factors are stigmatized.
In five studies, researchers showed that when a health-related message, such as a public service announcement about lung cancer screening, mentions a stigmatized risk factor, it “smears” the morality of healthy behavior that the message supports . And that makes people less likely to engage in the behavior when it threatens their moral sense of self.
“We show that people make trade-offs where they choose to protect their moral self by not getting the help they might need,” says Achar. “You can either be a ‘good person,’ they might think, or a not-so-good person who goes to seek help with an illness that has stigmatized risk factors.”
Handling Ethics and Stigma
The researchers conducted five studies where they varied both the extent of stigma associated with health-related risk factors and the sense of moral identity that participants felt.
For example, several studies showed participants messages about cancer screening. In one of these experiments, some participants were first asked to write about themselves using moral personality traits (to create a sense of moral identity), while others wrote about themselves in more generally positive terms. Next, some participants read a newspaper article about the stigma associated with smoking, while others read an article about a neutral topic, such as the history of coffee. All participants then viewed an ad about lung cancer screening that mentioned smoking as a risk factor.
In another experiment, some participants were shown a cancer screening ad that emphasized high-stigma risk factors such as smoking, while others saw ads that emphasized low-stigma factors such as pollution exposure.
Overall, the results showed that people who had a moral sense of self were more likely to say they would use a lung cancer screening tool when they were not reminded of the stigma associated with risk factors such as smoking. And this same group became less interested in control when these stigmatizing factors became apparent.
Interestingly, participants’ sense of moral identity changed how they perceived their actual risk of lung cancer. Participants in the high-stigma condition estimated their lung cancer risks to be nearly 20 percent lower when they began to acquire a moral identity, compared to those who were not prepared in this way.
“In theory,” says Achar, “everyone should be calculating the same risk. But when they define themselves as a “good” person, they say to themselves, “I’m not the kind of person who gets this disease.”
This perception of risk in turn influenced the time participants spent on a screening tool embedded in some of the studies. “They spend less time on the tool if they think they’re not the kind of person who gets that kind of cancer,” Achars says. “I don’t need this control,” they say. And this of course increases the risk of them ending up with a health problem.
Ethics and Health
“One of the important contributions of this work is to link the moral self to health,” says Achar.
Indeed, on the one hand the results show that our sense of moral self can motivate us to behave in ways that are good for our health. People with a moral identity were more likely to do something healthy than those who were not prepared, such as intending to get a vaccine for a fictitious disease they had been told. “Someone who cares about being a good person wants to take care of themselves, because being healthy is virtuous,” he says. “Being healthy is virtuous in terms of self-control, because it means you can resist things that are not good for you. But health is also virtuous from a public health perspective. “Historically, healthy people have reduced the spread of disease and created better-functioning and more productive societies.”
But the relationship between morality and health breaks down when stigma comes into play, as the results showed. “The moral self makes someone more likely to act in a healthy way, but then stigma is this bad thing that takes away the skill of health behaviors,” says Achar.
A natural implication of the findings, then, is that health-related messages that highlight stigmatized risk factors may reduce people’s motivation to choose the healthier option. Thus, public health agencies may be wise to avoid mentioning smoking in messages encouraging cancer screening or obesity in messages encouraging diabetes interventions.
Stigma and Ideology
This connection between ethics and health could also influence the battle over COVID-19 mitigation measures—particularly when it comes to forms of vaccination hesitancy.
“Much of the literature shows that political identity is intrinsically related to moral beliefs because ideology is a sense of how an ideal society should be run.” says Ahar. “In this way, anything ideologically consistent could be seen as moral or ‘good’ behavior.”
In the case of COVID, many mitigation behaviors, such as coverage and vaccination, have been stigmatized in some circles. “Stigma is again a threat to people’s view of themselves as good people. They worry about the social cost or ‘What does this say about me?”’
This suggests that, just as public health organizations wishing to support a health behavior such as lung cancer screening should redirect attention away from stigmatized risk factors such as smoking to innocuous risk factors such as pollution, public health organizations will it was wise to redirect the vaccination defense away from associations or reminders about ideology.
